Smoking cessation behavior in patients with a diagnosis of a non-communicable disease: The impact of perceived disease severity of and susceptibility to the disease.

INTRODUCTION: The Health Belief Model comprises two constructs influencing changed behaviors impacting on health, namely perceived severity and susceptibility. The aim of this study was to identify the impact of the combination of, or interactions between, these two constructs on quitting smoking in smokers with a diagnosis of a non-communicable disease (NCD). METHODS: From the large insurance claims database maintained by JMDC database (JMDC, Tokyo), we extracted data on 13284 participants who smoked. All participants were stratified according to their NCD diagnosis based on perceived severity and susceptibility as follows: Category I (high severity and high susceptibility) - acute myocardial infarction, and lung cancer; Category II (high severity and low susceptibility) - colorectal cancer, and stomach cancer; Category III (low severity and high susceptibility) - asthma, and transient ischemic attack; Category IV (low severity and low susceptibility) - appendicitis, and glaucoma. We performed multi-variable logistic regression analysis and calculated the proportion of those who were smoking at the first health check-up after the diagnosis and every three years thereafter. RESULTS: Using glaucoma as the reference, the adjusted odds ratios for smoking cessation were 14.2 (95% CI: 11.4-17.8) to 14.8 (95% CI: 12.5-17.4) in Category I; 4.5 (95% CI: 3.8-5.4) to 6.6 (95% CI: 5.4-8.0) in Category II; and 1.9 (95% CI: 1.7-2.1) to 2.8 (95% CI: 2.2-3.7) in Category III. In Categories I and II, the proportion of smokers rapidly decreased after diagnosis and mostly remained low thereafter. Smoking cessation rates for Categories I and II were not associated with readiness to improve lifestyles prior to NCD diagnosis. CONCLUSIONS: Our study confirms the significant impact of perceived severity of and susceptibility to the diagnosed disease on smoking cessation. The multiplicative effect of these two constructs at NCD diagnosis represents a 'teachable moment', a window of opportunity, for encouraging successful long-term smoking cessation.

Effects of External Radiation Exposure on Perinatal Outcomes in Pregnant Women After the Fukushima Daiichi Nuclear Power Plant Accident: the Fukushima Health Management Survey.

BACKGROUND: This study aimed to investigate the effects of maternal exposure to external radiation on perinatal outcomes among women who experienced the Fukushima Daiichi Nuclear Disaster (FDND) using the Fukushima Health Management Survey (FHMS). METHODS: Data from the Pregnancy and Birth Survey and Basic Survey in the FHMS were combined to analyze external maternal radiation exposure following the FDND, and the relationship between radiation dose and perinatal outcomes was analyzed using binomial logistic regression analysis. Missing dose data were supplemented using multiple imputation. RESULTS: A total of 6,875 individuals responded to the survey. Congenital anomalies occurred in 2.9% of patients, low birth weight (LBW) in 7.6%, small for gestation age (SGA; <10th percentile) in 8.9%, and preterm birth in 4.1%. The median maternal external radiation dose was 0.5 mSv (maximum, 5.2 mSv). Doses were classified as follows: <1 mSv (reference), 1 to <2 mSv, and ≥2 mSv. For congenital anomalies, the crude odds ratio for 1 to <2 mSv was 0.81 (95% confidence interval [CI], 0.56-1.17) (no participants with congenital anomaly were exposed to ≥2 mSv). At 1 to <2 mSv and ≥2 mSv, the respective adjusted odds ratios were 0.91 (95% CI, 0.71-1.18) and 1.21 (95% CI, 0.53-2.79) for LBW, 1.14 (95% CI, 0.92-1.42) and 0.84 (95% CI, 0.30-2.37) for SGA, and 0.91 (95% CI, 0.65-1.29) and 1.05 (95% CI, 0.22-4.87) for preterm birth. CONCLUSION: External radiation dose due to the FDND was not associated with congenital anomalies, LBW, SGA, or preterm birth.

Smoking cessation after cancer diagnosis reduces the risk of severe cancer pain: A longitudinal cohort study.

BACKGROUND: Whether abstinence from smoking among cancer patients reduces cancer pain is still unclear. Opioids can act as a surrogate index for evaluating the incidence of severe cancer pain in countries where opioid abuse is infrequent. This study aimed to investigate whether changed smoking behavior after cancer diagnosis influences the incidence of severe cancer pain as determined by strong opioid use. METHODS: Using a large Japanese insurance claims database (n = 4,797,329), we selected 794,702 insured employees whose annual health checkup data could be confirmed ≥6 times between January 2009 and December 2018. We selected 591 study subjects from 3,256 employees who were diagnosed with cancer pain and had health checkup data at the year of cancer pain diagnosis. RESULTS: A significantly greater proportion of patients who continued smoking after cancer diagnosis ("current smoker", n = 133) received strong opioids (36.8%) compared with patients who had never smoked or had stopped before cancer diagnosis ("non-smoker", n = 383, 20.6%; p<0.05) but also compared with patients who had quit smoking after cancer diagnosis ("abstainer:", n = 75, 24.0%; p<0.05). In multivariable Cox proportional hazards regression analysis, abstainers had a significantly lower risk of receiving strong opioids than current smokers (hazard ratio: 0.57, 95% CI: 0.328 to 0.997). These findings were consistent across multiple sensitivity analyses. CONCLUSION: Our study demonstrated that patients who quit smoking after cancer diagnosis have a lower risk of severe cancer pain. This information adds clinical incentives for improving quality of life among those who smoked at the time of cancer diagnosis.

The impact of the National Health Program on diabetes incidence among working-age men with prediabetes: A regression discontinuity analysis of a nation-wide database in Japan.

AIM: This study aimed to investigate the impact of the National Health Program in Japan ("Specific Health Check-ups and Specific Health Guidance") on diabetes prevention among working-age men with prediabetes. METHODS: This study used a regression discontinuity design, based on the program's criterion that the program starts at age 40 or older and that the intervention is provided only to prediabetic individuals with abdominal obesity, to assess the impact of the program on the diabetes incidence in a total of 49,848 men with prediabetes, aged 37-42 years. RESULTS: The National Health Program in which interventions were provided for individuals aged 40 years or over with both prediabetes and abdominal obesity was associated with a decrease in diabetes incidence rate equivalent to 10.1 reduction/1000 person-years. The relative risk was 0.75. However, among those without abdominal obesity and not subjected to the intervention, there was no significant change in the diabetes incidence at age 40. CONCLUSIONS: The National Health Program in Japan was associated with a decrease in the incidence of diabetes among working-age men with prediabetes and abdominal obesity and may have a meaningful impact among working-age men.

Factors Associated With Smoking Relapse Among Women in Japan From Pregnancy to Early Parenthood.

OBJECTIVE: To identify factors, including mental health, associated with smoking relapse among women in Japan from pregnancy to early parenthood. DESIGN: Secondary analysis of data from an ongoing cross-sectional study conducted between 2013 and 2016. SETTING: We mailed questionnaires to all women who received a maternal and child health handbook from a municipality in Fukushima Prefecture or who underwent a maternal health checkup and gave birth in Fukushima Prefecture. PARTICIPANTS: Of the 28,562 women who responded to the questionnaire, 6,747 who previously smoked and quit around the time they registered their pregnancies were included in the analysis. METHODS: Participants were divided into groups according to smoking relapse status: a nonrelapse group, which included those who maintained smoking cessation, and a relapse group, which included those who quit smoking but later relapsed. We further classified the latter group into those who quit smoking before or after pregnancy registration. We used a logistic regression model with forced entry to calculate adjusted odds ratios. RESULTS: Of the 6,747 participants who previously smoked, 881 (13.1%) relapsed. Regardless of the timing of smoking cessation, younger age and living in a specific region of Fukushima Prefecture were associated with smoking relapse. Relapse was associated with symptoms of depression in participants who quit smoking before registration and with multiparity in participants who quit smoking after registration of their pregnancies. CONCLUSIONS: Support for women at risk of smoking relapse after pregnancy requires consideration of regional characteristics and incorporation of family and mental health support with a focus on younger women.

Effect of maternal smoking during pregnancy on gestational weight gain and birthweight: A stratified analysis by pregestational weight status.

INTRODUCTION: In Japan, low birthweight (LBW) of infants is a major public health concern. Gestational weight gain (GWG) may be associated with LBW of infants. On the other hand, maternal smoking during pregnancy is a well-known factor associated with infant birthweight. Thus, this study aimed to examine the effect of maternal smoking during pregnancy on GWG and birthweight stratified by pregestational weight status. METHODS: A retrospective cohort study was designed, which included three hospitals of Yamanashi Prefecture, Japan. The study included babies born between 2013 and 2014 from mothers having singleton pregnancies. The outcomes analyzed were GWG (difference between maternal weight measured at prenatal check-up just before delivery and pregestational weight based on information from clinical records) and birthweight of infants stratified by pregestational maternal body mass index (BMI). RESULTS: This study included 1150 singleton babies and their mothers. After excluding individuals with incomplete data, the final number of analyzed participants was 1078. The mean maternal age at delivery was 31.3 ± 5.1 years. The mean pregestational BMI was 21.3 ± 3.4 kg/m2. The mean GWG was 10.0 ± 4.1 kg. After adjusting for confounding factors, maternal smoking during pregnancy was positively associated with GWG in all categories (underweight: p<0.0001; normal weight: p<0.0001; overweight: p=0.01). Maternal smoking during pregnancy was also significantly associated with lower birthweight in underweight and normal-weight mothers (underweight: p=0.04, normal-weight: p=0.03). CONCLUSIONS: Maternal smoking status is significantly associated with higher GWG and lower birthweight. Based on the Developmental Origins of Health and Disease (DOHaD) hypothesis, the growth of infants born from smoking mothers needs close observation.

Adenomyosis as a Potential Risk Factor for Adverse Pregnancy Outcomes: A Multicenter Case-Control Study.

As the number of women who postpone their first pregnancy until their late 30s or early 40s is increasing, adenomyosis is more frequently encountered by obstetricians. Some studies have reported on the relationship between adenomyosis and pregnancy complications. We aimed to investigate the effect of adenomyosis on pregnancy complications and outcomes and associations between adenomyosis type and pregnancy outcomes. This multicenter retrospective 1:4 case-control study included 61 women with singleton pregnancies diagnosed with adenomyosis. The control group included women with singleton pregnancies without adenomyosis; these women were matched to those with adenomyosis using propensity scores. The incidence of obstetric complications, delivery, and neonatal outcomes were compared. The adenomyosis group (n = 61) had significantly higher incidence of preterm delivery (21.3% vs. 9.4%), hypertensive disorders of pregnancy (13.1% vs. 5.3%), cesarean delivery (46.0% vs. 20.9%), and postpartum hemorrhage (57.3% vs. 36.8%) than the control group (n = 244). Subgroup analysis by the adenomyosis type revealed that the diffuse adenomyosis group (n = 41) was significantly more likely to experience preterm labor (29.3% vs. 7.3%), hypertensive disorders of pregnancy (17.0% vs. 5.5%), severe hypertensive disorders of pregnancy (12.2% vs. 1.8%), preterm premature rupture of membranes (12.2% vs. 2.4%), cesarean delivery (61.3% vs. 18.9%), and postpartum hemorrhage (70.7% vs. 44.5%) than the control group (n = 164). The focal adenomyosis (n = 20) group was not statistically different from the control group (n = 80) with respect to obstetric complications. Women with diffuse adenomyosis require more careful perinatal management than previously thought.

Association between infertility treatment and intrauterine growth: a multilevel analysis in a retrospective cohort study.

OBJECTIVES: This study aimed to identify intrauterine growth differences according to infertility treatment compared with spontaneous conception and to describe intrauterine growth trajectories. DESIGN: Retrospective cohort study. SETTING: A single primary and tertiary medical centre in Japan. PARTICIPANTS: This study included singleton pregnant women with prenatal check-ups and delivery at the University of Yamanashi Hospital between 1 July 2012 and 30 September 2017. Patients were divided into four groups: spontaneous conception, infertility treatment without assisted reproductive technology (ART), fresh-embryo transfer and frozen embryo transfer (FET). INTERVENTIONS: Differences in intrauterine growth according to the infertility treatment, including ART, and birth weight were evaluated. Multilevel analysis was employed to evaluate intrauterine growth trajectories stratified by the sex of the offspring. PRIMARY OUTCOME MEASURE: Estimated fetal weight (EFW) assessed by ultrasound examination. RESULTS: We assessed data from 37 239 prenatal examination results from 2377 pregnant women (spontaneous conception, n=1764; infertility treatment without ART, n=171; fresh-embryo transfer, n=112; and FET, n=330) in the final analysis. Multilevel analysis was adjusted for gestation duration, gestation period, parity, hypertensive disorders of pregnancy, type of infertility treatment, maternal age, smoking status, placenta previa, thyroid disease, gestational diabetes mellitus and the interaction between each potential confounding factor and gestation duration. In male fetuses, the interaction between FET and gestational duration (estimate: 0.36; 95% CI: 0.06 to 0.67) significantly affected the EFW. Similarly, in female fetuses, FET (estimate: -69.85; 95% CI: -112.09 to -27.61) and the interaction between FET and gestation duration (estimate: 0.57; 95% CI: 0.28 to 0.87) significantly affected the EFW. CONCLUSIONS: This study shows that FET affects intrauterine growth trajectory from the second trimester to term, particularly in female fetuses. Our findings require further prospective research to examine the effect of infertility treatment on fetal growth.

Effect of maternal active smoking during pregnancy on the trajectory of childhood body mass index: A multilevel analysis using quartiles of birthweight.

INTRODUCTION: Maternal active smoking during pregnancy is associated with childhood obesity; however, whether maternal active smoking affects childhood body mass index (BMI) according to birthweight has not been examined. METHODS: The study participants were 1955 women and their single-born infants, born between 1 April 1991 and 31 March 2003, in Koshu City, Japan, for whom complete data for birthweight, pre-pregnancy maternal BMI and pregnancy smoking status were available. Maternal smoking status during pregnancy was recorded using a questionnaire at the time of pregnancy registration. Childhood BMI was estimated by the BMI z-score, established by the World Health Organisation. Birthweight quartiles were grouped by sex and parity (first vs second or higher). Multilevel analysis, including both the individual and time as different level variables by each birthweight quartile, was used to describe the trajectories of BMI z-scores for statistical analyses. RESULTS: In every quartile group, although children born to smoking mothers were leaner at birth, their BMI z-score increased around the age of 3 years. These children were larger than children born to non-smoking mothers. Significant interactions between maternal active smoking during pregnancy and child's age were seen in those in the first and second quartiles of birthweight. Moreover, rapid growth in infancy was observed in the second quartile of birthweight. CONCLUSIONS: The effect of maternal active smoking during pregnancy on childhood growth was more apparent among children in the second quartile of birthweight.

Association of household smoking status in childhood with young adults' educational attainment and smoking status: Results from a series of population-based cross-sectional surveys in Japan.

Smoking in young adulthood is a risk factor for future health-related disabilities and a cause of expanding health inequalities. Education and smoking are inversely associated. Using population-based representative data, this study aimed to clarify how the presence of household smokers during childhood related to both current smoking status and educational attainment among young adults. Surveys were distributed to young adults (19-20 years) invited to coming-of-age ceremonies in 2014-2017 in a rural area in Japan. Data were collected on low educational attainment (defined as ≤ 12 years of education), current smoking status, and childhood household smoking status. We used logistic regression models to calculate odds ratios (ORs) of low educational attainment for household smoking status. A total of 17.6% of men (n = 1077) and 3.8% of women (n = 1021) were current smokers. Current smoking was more common among participants from households with smokers (P < 0.001 for both men and women). The odds of low educational attainment were significantly higher for participants from smoking households (OR: 1.59, 95% confidence interval [CI]: 1.17-2.17 for men; OR: 2.29, 95% CI: 1.61-3.24, for women). All associations were characterized by a dose-response relationship with the number of household smokers. The number of household smokers in childhood was positively associated with current smoking and negatively associated with level of educational attainment among young adults. Controlling for year and geographical area, exposure to family smokers in childhood appears to be a risk factor for the intergenerational transmission of health inequalities.

Description of Maternal Smoking Status Before and After Pregnancy: A Longitudinal, Community-Based Cohort Study.

BACKGROUND: Maternal smoking during pregnancy is a major risk for adverse perinatal outcomes, as well as children's health status. Thus, it is important to describe maternal smoking status during pregnancy and child-rearing to devise better intervention strategies. However, there have been no longitudinal studies to describe the status. Thus, in this study, we aimed to describe maternal smoking status during pregnancy and child-rearing based on population-based maternal and child health information. Moreover, we explored the factors associated with maternal smoking relapse after delivery. METHODS: We performed a survey of 1,220 mothers in a Japanese rural area who responded to a questionnaire upon registration of their pregnancies. When their children received health checkups at 4, 18, and 36 months of age, maternal smoking status was also surveyed. We then performed multiple logistic regression analysis to explore factors associated with maternal smoking relapse after delivery. RESULTS: Ultimately, the total number of mothers with data available for longitudinal analysis was 727 (59.6%). At the time of pregnancy registration, there were 74 current smokers (10.2%) and 176 former smokers (24.2%). Among them, 59 (33.5%) relapsed after delivery. Under 28 years of maternal age at pregnancy registration (OR 2.6; 95% CI, 1.2-5.4) was associated with maternal smoking relapse after delivery. CONCLUSIONS: Longitudinal analyses showed that about 60% of mothers who smoked before and after delivery failed smoking cessation. In addition, younger mothers were significantly likely to relapse smoking after delivery.

Ninety babies born after round spermatid injection into oocytes: survey of their development from fertilization to 2 years of age.

OBJECTIVE: To compare physical and cognitive development of babies born after round spermatid injection (ROSI) with those born after natural conception. DESIGN: Comparison of efficiencies of ROSI and ICSI using testicular spermatozoa, performed in the St. Mother Clinic. Physical and cognitive development of ROSI babies recorded by parents in the government-issued Mother-Child Handbook was checked and verified by attending pediatricians. Data included baby's weight gain and response to parents' voice/gesture. SETTING: Assisted reproduction technology practice. PATIENT(S): A total of 721 men participated in ROSI; 90 ROSI babies were followed for 2 years for their physical and cognitive development. Control subjects were 1,818 naturally born babies. INTERVENTION(S): Surgical retrieval of spermatogenic cells from testes; selection and injection of round spermatids into oocytes; oocyte activation, in vitro culture of fertilized eggs, and embryo transfer to mothers. MAIN OUTCOME MEASURE(S): Physical and cognitive development of ROSI babies (e.g., body weight increase, response to parents, and understanding and speaking simple language) compared with naturally born babies. RESULT(S): Of 90 ROSI babies, three had congenital aberrations at birth, which corrected spontaneously (ventricular septa) or after surgery (cleft lip and omphalocele). Physical and cognitive development of ROSI babies was similar to those of naturally born babies. CONCLUSION(S): There were no significant differences between ROSI and naturally conceived babies in either physical or cognitive development during the first 2 years after birth. CLINICAL TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry UMIN000006117.

Primary synovial sarcoma of the left heart with large amount of necrotic tissue.

We present a case of primary synovial sarcoma arising from the left heart, an extremely rare occurrence, with a large amount of necrotic tissue, which suggested a poor prognosis. After incomplete tumor resection, chemotherapy and radiation therapy were performed; however, PET/CT findings at 26 months after the operation revealed local recurrence. Although we performed two additional operations following chemotherapy, the patient died from local recurrence at 36 months after the initial operation. In this case of synovial sarcoma arising from the left heart, even though aggressive multimodality therapy was performed, the prognosis was still poor.

Association Between Maternal Smoking During Pregnancy and Birth Weight: An Appropriately Adjusted Model From the Japan Environment and Children's Study.

BACKGROUND: There has been no large nationwide population-based study to examine the effects of maternal smoking status during pregnancy on birth weight that simultaneously controlled for clinical information, socioeconomic status, and maternal weight. Thus, this study aimed to determine the association between maternal smoking status during pregnancy and birth weight, while taking these confounding factors into consideration. METHODS: This study examined the first-year fixed dataset from a large nationwide birth cohort study that commenced in 2011. The dataset consisted of information on 9369 singleton infants born before December 31, 2011. Children were divided into 4 groups for statistical analysis: those born to mothers who did not smoke (NS), who quit smoking before pregnancy, who quit smoking during early pregnancy, and who smoked (SM). Multiple linear regression models were conducted for each sex to examine the association between maternal smoking status during early pregnancy and fetal growth. Birth weight was estimated using the least-squares method after controlling for covariates. RESULTS: After controlling for potential confounding factors, maternal smoking status during pregnancy was significantly associated with birth weight. There was a significant difference in birth weight between NS and SM for both male and female infants (male infants, 3096.2 g [NS] vs 2959.8 g [SM], P < 0.001; female infants, 3018.2 g [NS] vs 2893.7 g [SM], P < 0.001). CONCLUSIONS: Using data from a large nationwide birth cohort study in Japan, we have shown that maternal smoking during pregnancy may reduce birth weight by 125-136 g.

Association between Maternal Smoking during Pregnancy and Low Birthweight: Effects by Maternal Age.

BACKGROUND: Maternal smoking during pregnancy has been consistently related to low birthweight. However, older mothers, who are already at risk of giving birth to low birthweight infants, might be even more susceptible to the effects of maternal smoking. Therefore, this study aimed to examine the modified association between maternal smoking and low birthweight by maternal age. METHODS: Data were obtained from a questionnaire survey of all mothers of children born between 2004 and 2010 in Okinawa, Japan who underwent medical check-ups at age 3 months. Variables assessed were maternal smoking during pregnancy, maternal age, gestational age, parity, birth year, and complications during pregnancy. Stratified analyses were performed using a logistic regression model. RESULTS: In total, 92641 participants provided complete information on all variables. Over the 7 years studied, the proportion of mothers smoking during pregnancy decreased from 10.6% to 5.0%, while the prevalence of low birthweight did not change remarkably (around 10%). Maternal smoking was significantly associated with low birthweight in all age groups. The strength of the association increased with maternal age, both in crude and adjusted models. CONCLUSIONS: Consistent with previous studies conducted in Western countries, this study demonstrates that maternal age has a modifying effect on the association between maternal smoking and birthweight. This finding suggests that specific education and health care programs for older smoking mothers are important to improve their foetal growth.

Childhood growth trajectories according to combinations of pregestational weight status and maternal smoking during pregnancy: a multilevel analysis.

Pregestational weight status and maternal smoking during pregnancy are significantly associated with fetal and childhood growth. However, few studies have examined associations between childhood growth and combinations of these factors using multilevel analysis. This study aimed to describe differences in childhood growth trajectories according to these combinations, using data from a prospective cohort study in Japan. The study participants were 1,973 women and their singletons, who were born between April 1, 1991 and March 31, 2003. Children were categorized according to whether they were born to normal-weight, nonsmoking mothers (NN); normal-weight, smoking mothers (NS); underweight, nonsmoking mothers (UN); underweight, smoking mothers (US); overweight, nonsmoking mothers (ON); or overweight, smoking mothers (OS). Birth weight and anthropometric data were collected from 1,965 children at birth (99.6%), 1,655 aged 3 (83.9%), 1,527 aged 5 (77.4%), 1,497 aged 7-8 (75.9%), and 1,501 aged 9-10 (76.1%). Multilevel analysis examining both individual and age as different level variables according to sex was used to describe the trajectories of body mass index z scores for statistical analyses. Although children of the OS group were the leanest at birth, their body mass indices had increased rapidly by 3 years of age. Moreover, body mass index was also likely to increase in boys in the NS and ON groups. A different trend was observed in girls. Body mass index decreased from 5 years of age in girls in the US group. There were no remarkable differences in body mass index trajectories between children in the other groups. In conclusion, childhood growth trajectories differed according to combinations of pregestational weight status and maternal smoking during pregnancy. Further, there were sex-related differences in the associations between childhood growth and factor combinations.

Maternal smoking during pregnancy and growth in infancy: a covariance structure analysis.

BACKGROUND: Smoking during pregnancy is related to fetal constraint and accelerated postnatal growth. However, the pathways between these factors have not been clarified. Pathway analyses that link these factors can help us better understand the mechanisms involved in this association. Therefore, this study aimed to examine pathways between maternal smoking during pregnancy and growth in infancy. METHODS: Participants were singletons born between 1993 and 2006 in rural Japan. The outcome was the change in weight z-score between birth and 3 years of age. Pathways from maternal smoking and other maternal factors (such as maternal body mass index and work status) to growth in infancy via birth factors (such as birth weight and gestational age) and breastfeeding were examined using structural equation modeling. RESULTS: Complete data were available for 1524 children (775 boys and 749 girls). The model fit appeared adequate. Lower birth weight and non-exclusive breastfeeding mediated the association between maternal smoking during pregnancy and rapid growth in infancy. Maternal smoking was also directly linked to rapid growth in infancy (standardized direct effects 0.06, P = 0.002). Taking all pathways into account, the standardized total effect of maternal smoking on growth in infancy was 0.11. CONCLUSIONS: Maternal smoking during pregnancy may both indirectly, through birth weight and breastfeeding status, and directly influence growth during infancy; however, there may be other pathways that have not yet been identified.

Longitudinal analyses of childhood growth: evidence from Project Koshu.

Recently, it has been suggested that fetal and infant environments are associated with childhood and adulthood health status, specifically regarding presence of obesity and chronic diseases. This concept is known as the "Developmental Origins of Health and Disease (DOHaD) hypothesis." Thus, it is necessary to collect information about the fetal and infancy periods in order to examine the association between fetal and infancy exposures and later growth. Based on the DOHaD hypothesis, childhood growth trajectories, which were described by multilevel analysis, might be important in examining the effects of early-life environment on later-life health. The author and colleagues examined the association between maternal smoking during pregnancy and fetal/childhood growth, specifically risk of childhood obesity, by using the dataset from an ongoing prospective cohort study called "Project Koshu," which enrolled pregnant women and their children from a rural area of Japan. Children born to smoking mothers were likely to have lower birth weights and, thereafter, to show an increase in body mass index compared to children of non-smoking mothers. Differences in pubertal growth patterns by gender and childhood weight status were then examined. Growth rate and height gain trajectories were similar between genders, although pubertal growth spurts were observed earlier in girls than in boys. The overweight/obese children grew faster than did the non-overweight children in the early pubertal stages, and the non-overweight children caught up and showed greater height gains at older ages. Because Project Koshu is ongoing, further studies examining new research questions will be conducted with larger sample sizes.

Effect of maternal smoking cessation before and during early pregnancy on fetal and childhood growth.

BACKGROUND: Maternal smoking during pregnancy is a major cause of intrauterine growth restriction and childhood obesity, but only a few studies have examined the association of smoking cessation before and during pregnancy with fetal and childhood growth. We examined this association in a prospective cohort study in Japan. METHODS: Our study included children born between 1991 and 2006 and their mothers. Using a questionnaire, maternal smoking status was recorded at pregnancy. The anthropometric data of the children were collected during a medical check-up at age 3 years. Multiple linear and logistic regression models were used for data analysis stratified by sex. RESULTS: In total, 2663 mothers reported their smoking status during early pregnancy, and data were collected from 2230 (83.7%) children at age 3 years. Maternal smoking during pregnancy was associated with a significant reduction in birth weight (approximately 120-150 g). Body mass index at age 3 years was significantly higher among boys born to smoking mothers than among boys born to nonsmoking mothers. Maternal smoking during pregnancy was associated with overweight at age 3 years among boys (adjusted odds ratio, 2.4; 95% CI, 1.03-5.4). However, among women who stopped smoking in early pregnancy, there was no increase in the risks of a small for gestational age birth or childhood overweight at age 3 years. CONCLUSIONS: Children born to mothers who stopped smoking before or during early pregnancy had appropriate fetal and childhood growth.